Sonography has been proven to be an accurate method for diagnosing a hip effusion in children, and its use in the diagnosis of pediatric joint effusions and septic arthritis is now commonplace . In contrast, sonography is not widely used to detect hip joint effusions in adults, with both sonography and fluoroscopically guided aspiration being used for this purpose.
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Several authors have reported successful use of sonography to detect an effusion in the native adult hip  and to assess for a septic joint . Sonography has also been used to assess joint effusion after hip arthroplasty . The main sonographic finding for hip joint effusion in the native adult hip is anterior capsule distension of 7 mm or more and 1 mm or more, and greater distention of the symptomatic hip when compared with the asymptomatic hip . In the postoperative hip, anterior pseudocapsule distension of 3.2 mm or more at the proximal anterior femoral cortex indicates an infected hip prosthesis . Although capsular distention is indicative of a hip effusion, the size and gray scale appearance of a joint effusion does not predict if the effusion has an infectious or inflammatory etiology . In addition, increased power Doppler flow also does not distinguish between fluid collections caused by infection and noninfectious etiologies.
The reliability of sonography to detect a hip effusion in an adult has recently been questioned, however. Weybright and colleagues  reported that anterior capsular distention seen on sonography is not accurate in the detection of hip joint effusion in the adult patient for either native or postsurgical hips. Aspiration of the joint was found to be necessary to confirm or exclude the presence of a joint effusion. Those authors did find that sonography is useful in diagnosing extra-articular soft-tissue fluid collections and to guide hip joint aspiration.
Although the authors usually use fluoroscopy to guide aspiration of the hip, the authors have found that ultrasound provides a rapid and efficient method for guiding aspiration or injection of the hip joint (Fig. 1). Sofka and colleagues  felt that the absence of radiation and relatively short procedure time of so-nography-guided hip injections makes sonography the imaging guidance of choice.
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